Rural Voice carries the story
The image rural people like to hold of country life is that fresh air and exercise make it a healthy place to live. The sad reality of statistics gathered by the Canadian Community Health Survey by Statistics Canada in 2005, show Huron and Perth counties near the top or leading in categories such as heart disease, high blood pressure, obesity and diabetes.
The Gateway Rural Health Research Institute, which officially opened in September, has already commenced research into the heightened rate of diabetes in the Institute’s four surrounding counties, Huron, Perth, Bruce and Grey. It’s part of the new Institute’s mission to tackle rural-specific health concerns. The Institute plans on focusing on tangible rural health issues such as heighten-ed rates of diabetes, obesity and cardio-vascular diseases as well as the intangible concern of a region-wide shortage of healthcare professionals.
However, the aim of the Institute is much higher. “We want to get our feet under us in the immediate future and we realize that we have to walk before we can run,” says Lin Steffler, president of the Institute’s board of directors. “We have contacted a number of organizations for funding and these requests are all in the works right now, so that will get us up and running. So the immediate process is gathering the dollars and then the staff to help Dr. [Claudio] Munoz bring it all together. “In the long term, we want to be able to strengthen rural Ontario and southwestern Ontario to such a point that when anyone needs research done in a rural aspect, they come to us. We’ll start off province-wide, then we’ll go national and then we’ll go international.”
While discussion had been ongoing for several years about attracting doctors to rural Ontario, it wasn’t until Huron-Perth physician recruitment officer Gwen Devereaux searched the words “rural” and “health” on Google that she came upon the University of Kentucky Center for Excellence in Rural Health and became inspired. After discussing the possibility of a similar concept in Huron County with several players in local healthcare and members of municipal government, a trip was organized that sent 15 people to Hazard, Kentucky for a tour. The group met with Dr. Baretta Casey, the Center’s director. They learned of the Center’s humble beginnings in 1990 to the award-winning facility it is today. The Center first came about because of legislation passed by the Common-wealth of Kentucky to address the healthcare needs of rural Kentuckians. The hopes behind the move were that it would strengthen the medical workforce and improve the healthcare received by area patients who were showing heightened rates of cardiovascular disease, hypertension, diabetes, obesity, depression, etc. Since its inception, the Center has won awards at the local, state and national level.
By the time they returned to Ontario, Devereaux had a vision and the support of her colleagues. However, while Huron County, specifically the Municipality of Huron East, had made significant progress in improving its healthcare with its Family Health Team as well as educational breakthroughs with Healthkick Huron, more work was needed to make the concept of a rural health centre in Huron County a reality. To address concerns over where the ever-growing Family Health Team and award-winning Healthkick Huron would be housed, Huron East council passed a motion to proceed with the construction of the Huron East Health Centre, which celebrated its grand opening in October.
With this move, the stars began to align in bringing a rural health centre to Seaforth. However, it was a donation from the McCall/McBain Foundation that put the final piece of the puzzle in place and provided the funding to bring Dr. Munoz onto the project as the Head of Research. Originally from Chile, where he obtained his MD, Munoz has MSc and PhD degrees in pharmacology and toxicology from the University of Western Ontario. He has worked on over 50 clinical trials of new cardiovascular drugs in Canada at the Hypertension Research Unit and then the Stroke Prevention and Atherosc-lerosis Research Centre of the London Health Sciences Centre and the Robarts Research Institute in London. Munoz is contracted to the centre for one year, but says he is currently in talks with Devereaux over a possible six-year extension.
The work of the entire centre can all be traced back to Munoz who has already begun work on a diabetes management project and hopes very soon to see two teams, one working on cardiovascular disease and the other on depression. Munoz is confident that Huron County is the ideal place to begin this research and says it is only a matter of time until he sees results. “I believe that Huron County, this is one of the best places in the world for clinical research, because of the demographic. We have an aging population here as well as the problems that come along with aging and the quality of the healthcare professionals is second to none,” Munoz says. “Because of that, I feel that we will be very productive on rural health issues and community-based research on the frontlines of care and because of that I think we can become a well-known area for community-based clinical research.”
Huron East mayor Joe Seili agrees with Munoz. He was a member of the group that travelled to Kentucky and was astonished with what he saw there. Initially, when Devereaux brought the idea to him, he said he thought “she was nuts,” but that the idea was worth looking into. However, the more he looked, the more he began to share her vision. “It only makes common sense, which there isn’t much of in politics anymore, that if you’re going to conduct rural research for rural people, that it should be done in a rural area,” Seili said. “With this being the only centre of its kind in Canada, we’ve always thought outside of the box here, so I think it’s a perfect setting.”
While Munoz looks forward to the research that awaits him and the Institute in the early stages, funding is a large concern, something he says might not be easy when considering Canada’s trends in research funding. “Very often programs are implemented from the government down to the community. It is amazing how often these programs do not work because the community is not involved,” Munoz says. “It’s a top-down approach, which for some things is the way to go, but in prevention and for chronic disease, there is nothing like a local community developing their own programs because they know what is available to them.” Munoz says throughout his medical career he has seen Canada be at the forefront of care and clinical research when it comes to medical academic centres and large urban centres, but lagging behind when it comes to rural health issues.
Being involved with the first project to invert the system is a very satisfying phase of his career, Munoz says. “I’m fortunate to be in a position to help out and develop these new initiatives. As far as we know, this is the first community-driven organization of research in Canada and that’s a very unique feature, because it’s the opposite of a top-down approach,” he says. “Here we’ll be working with a bottom-up approach, which is a nice way to go about conducting community-based research. We will be in a better position to engage the community, which is essential to prevention programs that will have an impact.” Munoz says he feels the future of research is in prevention and this is a viewpoint he hopes to bring to the Institute. He feels it isn’t too big a stretch of the imagination to envision a centre the likes of its sister centre in Kentucky in the future. He cites the similar population size of Hazard and Huron County.
Between Healthkick Huron and the Family Health Team in the building, the potential for growth and expansion is there and in the immediate future. The Huron Community Family Health Team stationed in Seaforth, (one of four in the region), is now fully-staffed and fully-operational. The team is comprised of a psychologist, a social worker, a dietitian, a pharmacist, a nurse practitioner and a primary care physician. “In Kentucky, they had a shortage of doctors and nurses as well as a widespread rural area that made it difficult for people to travel certain distances,” Steffler says. “They started off small and now they’ve got themselves to a place where doctors are training doctors as well as nurses, research is being done with some of the rural residents to address the areas of concern specific to their area and that’s exactly what we needed and what we wanted.”
As Gateway finds its feet, Casey and her team in Kentucky have been readily available for any questions or assistance the Seaforth team have needed. In fact, Devereaux says she has spoken to Casey about co-presenting at an international healthcare conference. With the relationship between the two centres strengthening in the months since the visit, Devereaux says expansion is already on her mind. “I see the relationship between Seaforth and Kentucky getting stronger very quickly, but our real goal is to work in Huron-Bruce first, then we hope to expand out to the other counties,” she says. “I think we’ll have a strong presence in Bruce County within a year.”
Devereaux has strong hopes that the establishment of the Institute will lead to the recruitment and retention of a greater number of healthcare professionals in the future, which is her first goal. “Recruitment and retention is always my goal. That’s my background and that’s my job,” she says. “Dr. Munoz is acutely aware that behind it all is recruitment and retention.” Seili said attracting more healthcare professionals to the area is always on the forefront of his thinking as well and he saw the potential when he travelled to Kentucky. “I feel this is in my job description to bring jobs to the area and this is one way of bringing decent, high-paying jobs,” he says. “I think it’s going to make it easier to attract young doctors to the area. We don’t have the cash the larger urban centres have to attract doctors, so this is one way they’ll know that we’re involved and behind healthcare.”
In the near-future, the Institute is hoping to receive funding to expand to include a project co-ordinator and a communications manager. The communications manager would be responsible for contacting organizations and federations and physicians and the project co-ordinator would be a liaison between doctors and Dr. Munoz on the research side of the project. Right now, however, Munoz is the only full-time employee on staff and he is continuing his work in London while he oversees the Institute. Steffler says there have already been people conducting independent studies getting in touch with Munoz as well as physicians seeing trends in their own practices wanting to work with the Institute to find out the reasons behind these trends.
“Eventually this will make a more efficient use of healthcare dollars. We will be able to specifically address the issues of our residents. It won’t be a broad spectrum of issues, it will be specific issues that will be able to help our residents,” Steffler says. “I think it was pretty close to the day that we put the shovel in the ground to build the building until we had the official opening, I think it was one year. That is an extremely strong commitment from the municipality and the people behind this project to get it done so quickly. We know where it can go and we are working towards that. This part of our area will be the rural healthcare capital of Ontario before we’re done.”
Written by Shawn Loughlin as it appeared in the December 2008 issue of The Rural Voice
